With GPs seemingly under fire from all sides – offered up as a diversionary punch-bag by some in the media while the government continues to underfund and mismanage the wider NHS – financial and recruitment issues in the primary care sector are putting patients’ health at risk.
Practices across the UK are expected to see profits plummet by up to a third over the next 12 months, according to one recent survey. The medical accountants association AISMA told Pulse magazine that, largely because of rocketing energy costs, rising inflation was eating into many practices’ budgets, and many of them would be left with no alternative but to cut staff or, even worse, shut down and hand back their contracts with the NHS.
That scenario goes some way to explaining the current GP recruitment crisis which has led to a shortage of 4,200 full-time-equivalent doctors across England – a figure which could hit almost 11,000 within the next decade, according to the Health Foundation thinktank.
Financial considerations must surely have played a part too in the picture emerging from Pulse magazine’s investigation last month, which found that over the past decade almost 480 practices – often in deprived areas – have permanently closed without merging with nearby practices or being replaced, in the process leaving close to 1.5m patients without a local GP.
Stress levels among already hard-pressed GPs, widely reported, is an inevitable knock-on effect of this scenario, and the situation hasn’t been helped by health secretary Therese Coffey’s controversial – but largely unenforceable – ‘plan for patients’, which aims to force doctors to see patients within two weeks of an appointment.
And the impact of those stress levels is only adding to the primary care sector’s recruitment problems, with the Royal College of GPs chair Professor Martin Marshall recently putting it: “A burnt-out GP is not able to practise safely.”
That awareness is echoed in this month’s study from the King’s Fund thinktank, which found that – because of safety concerns – just over 60 per cent of trainee GPs in England were planning to work part-time only, ie no more than six four-hour stints a week, after qualifying, and that barely 30 per cent were considering working full-time. The study also found that trainees were increasingly reluctant to become partners in GP practices because of the huge responsibilities involved.
Another impact is the growing presence in the private sector of former practice GPs, seeking to escape the pressures and prioritise their mental health – in the process exacerbating the staff shortages within the public sector.
In a recent interview with inews.co.uk, one such practitioner outlined the reasoning behind her decision to ‘go private’.
“A typical clinic for me [used to be] starting at 8.40am until about 12noon, full of ten-minute appointments. Then you repeated that again in the afternoon. It’s very intense. You’re seeing about 30-26 [sic] patients a day, and in some places it will be more. It’s quite a heavy workload. [Now] we have 20-minute appointments at our private clinic, which is probably standard for most private GPs – some will offer 30 minutes.”
The current cost-of-living crisis might make the expansion of the type of private surgery this particular GP works for – and the take-up among less affluent patients of the services it will offer – an unlikely prospect over the short-term, but the creeping privatisation of the work of local NHS-contracted surgeries continues, with often negative consequences for existing NHS patients.
Just consider the experience this month of one local practice in Lancashire, where the launch by the county’s ICB of a seasonal tourist triage phone line – costing £170,000, and apparently to be run on a for-profit basis by another contractor – was matched by the withdrawal of £73,000 in funding for the local practice, leading to the handing back of its NHS contract.
So now that the government are demanding that GPs provide shorter waiting times, they must surely ask themselves: what are we doing to support them?
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